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Dieting to Lose ... Seizures?

The ketogenic diet is a specialized diet used to control seizure activity in children and adolescents. This diet is typically utilized in children and adolescents whose seizures have not responded to multiple antiepileptic medications (also known as “intractable epilepsy”). It is also a growing treatment option for children with Lennox-Gastaut syndrome and Infantile Spasms.

Patients on this diet, require high-fat, low-carbohydrate content foods. This causes the body to begin utilizing fat as a source of energy rather than glucose – essentially mimicking a fasting state. During fasting, the body uses up its glucose stores and eventually begins to burn fat. Fat metabolism results in the release of ketones into the blood stream and brain. The goal of this diet is to maintain ketosis at all times. This is only one of the proposed mechanisms by which this diet works. This technique dates back to biblical times when epileptic patients who were starved eventually had a reduction in seizure frequency. The diet was used to treat epilepsy until it fell out of favor with the development of antiepileptic medications. There has been a resurgence of interest and positive reports in the literature since the 1990s.

The typical patient on the diet provides three to four parts fat for every one part carbohydrate and protein combined. This ratio is adjusted based on frequency of seizures, growth of the patient and tolerability of the diet. The types of foods that provide fat for the ketogenic diet include butter, cream and mayonnaise. Heavy whipping cream is a fat that is incorporated into every ketogenic meal.

The ketogenic diet has been found to completely prevent seizures in about one-third of patients and significantly reduces the occurrence of seizures in another one-third of patients. The remaining one-third are likely to see no results from the diet. These results prove the ketogenic diet to have the same efficacy as any antiepileptic medication. Unfortunately, this diet is not for everyone, as it is extremely restrictive and requires extensive time and planning.

Because the amount of carbohydrate and protein in the diet has to be restricted, it is important that meals are prepared and calculated carefully and that no other sources of carbohydrates or sugar are given. Achieving the low level of carbohydrate intake necessary can be challenging, as medications and products such as toothpaste, can contain high amounts of carbohydrates. It is important to consider ALL medications, both oral and intravenous (IV). As a rule, liquid medications are much worse offenders than other dosage forms. It is important to convert liquid medications (and sometimes chewable medications) to tablet form when possible in order to minimize these additional carbohydrates (i.e. Tylenol® liquid to Tylenol® tablets). Prescribers and pharmacists also have to be aware that dextrose is in many IV fluids and may be used as a diluent in IV medications. This is significant since dextrose counts as a carbohydrate and should be avoided in patients on the diet. Thus, it is very important to review all medications and assess for carbohydrate content for a patient on the ketogenic diet.